Provider Demographics
NPI:1629048830
Name:THOMPSON, SUSAN M (RN, APN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:CAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2475 MCCLELLAN AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4683
Mailing Address - Country:US
Mailing Address - Phone:856-675-3355
Mailing Address - Fax:
Practice Address - Street 1:2475 MCCLELLAN AVE BLDG C
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4683
Practice Address - Country:US
Practice Address - Phone:856-675-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO11378200163W00000X
NJNJ00033500363LG0600X
NJ26NJ00033500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023892Medicaid
NJ0023892Medicaid
NJ078461CKPMedicare ID - Type Unspecified